migratory nodular panniculitis
Introduction
Introduction to migratory nodular panniculitis Migratory nodular panniculitis is a special clinical syndrome characterized by the appearance of one or several reddish skin nodules in front of the bilateral or unilateral calves, and rapidly expanding toward the periphery, forming a hard Plaques can resolve on their own after a few months. Bafrested (1954) uses the term migratory nodular erythema to distinguish it from typical nodular erythema. Pinol (1956) describes the histopathological features of the disease in detail, and Prove that iodine has a good effect on this disease. basic knowledge The proportion of illness: 0.003% - 0.006% Susceptible people: no special people Mode of infection: non-infectious Complications: insomnia
Cause
The cause of migratory nodular panniculitis
(1) Causes of the disease
Not clear, may be related to bacterial and viral infections, often 1 to 20 days before the appearance of skin lesions have a history of acute upper respiratory tract infection, tonsillitis or acute laryngitis, in some cases after mild trauma, skin lesions, but skin No bacteria or viruses were found in the damage culture.
(two) pathogenesis
The pathogenesis is still unclear, presumably related to bacterial and viral infections, but in the culture of lesions, no bacteria or viruses were found.
Prevention
Migratory nodular panniculitis prevention
1. Strengthen nutrition, fasting and cold, pay attention to warming.
2. Early prevention and early diagnosis of secondary prevention.
Complication
Complications of migratory nodular panniculitis Complications insomnia
Some patients have tonsillitis or insomnia when they have skin lesions.
Symptom
Migratory nodular membranous inflammation symptoms Common symptoms Partial skin of the limbs... Joint pain nodules, low fever, insomnia
In the early stage of the disease, the lesion is a subcutaneous nodule with isolated mild induration, 0.5 to 2 cm in diameter, usually in front of the calf, and the skin on the surface of the nodule begins to be normal. After a few days, the surface of the skin becomes red, followed by the skin lesion by the newly emerging skin. Surrounded by damage, it is formed into an annular skin lesion. After dissipating, the local skin becomes thinner, the lesion is migratory, and the appearance is arched. In some patients, many nodules can be fused into large and hard plaques and enlarged to the surrounding area. With a diameter of up to 20cm, it can affect one or both sides of the ankle or knee joint within 2 or 3 weeks, and even affect the entire calf skin. The edge of the progressively enlarged lesion is reddish, and after the degenerative change in the lesion area, The skin is yellow or purple-blue, the plaque is hard, and it has a hard grainy feeling. There is no subcutaneous hemorrhage. Due to the involvement of lymphatic vessels, it can also cause swelling of the calf. The lesion plaque generally has no tendency to form ulcers.
Skin nodules are often the only clinical manifestations. Some patients may be associated with low fever, joint pain, general malaise, fatigue, poor appetite and insomnia, and some patients have tonsillitis when they have skin lesions.
Examine
Examination of migratory nodular panniculitis
Common erythrocyte sedimentation rate, even after the skin lesions subsided, erythrocyte sedimentation rate continued to increase, some patients with high "O" titer, other experimental tests were negative.
Skin lesion biopsy showed normal epidermis, mild inflammatory reaction in the subdermal layer, and expansion from the lipid membrane. The pathological changes were limited to the fat septum between the fat lobules. There may be a widening of the membrane, a large number of tissue cells and epithelioid multinuclear giants between the lobules. The cells are clustered, and there is cellulose deposition accompanied by fibrillar changes between the collagen bundles. The inflammatory reaction is very light, with mild lymphocytic infiltration, and the early lesions are mainly capillary proliferation.
Diagnosis
Diagnosis and differentiation of migratory nodular panniculitis
diagnosis
Where middle-aged women have asymptomatic red plaques on the unilateral calves, and gradually formed by a single nodule gradually expanding to the periphery, the center of the plaque disappears earlier, it should be highly suspected of the disease, if combined with medical history, pathological changes and Most patients can be diagnosed in response to iodine therapy.
Differential diagnosis
1. Nodular erythema: It is a cutaneous inflammatory disease of the skin. The skin nodules are good in the calf, but it can affect the dermis and subcutaneous tissue in different periods. There are characteristic skin lesions, and there is no central degenerative change in skin lesions. It is ring-shaped and does not gradually spread to the surrounding to form plaque. Histopathological changes are inflammatory changes of dermal connective tissue and vasculitis, which is ineffective with iodine.
2. Hard erythema: skin lesions occur in the bilateral calf flexion, the skin lesions are reddish blue, slightly higher than the skin, tenderness and spontaneous pain, no edge is ring-shaped and gradually tends to expand to the surrounding, The pathological changes were tuberculosis-like changes, which were ineffective with iodine.
3. Regression of hot nodular non-suppurative panniculitis: recurrent episodes of the disease, skin lesions appear in batches at each episode, often accompanied by high fever, joint pain, skin lesions occur in the limbs and trunk, subcutaneous Nodules or patches, varying in size, clear boundaries, reddish surface, mild tenderness, nodular rupture of lipid material, but no purulent, pathological changes including adipose tissue inflammatory changes, fibrous tissue and vascular lesions In addition, there are many system damages.
